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There is no simple way to look into your bones and see whether the inside structure has lost its strength so health professionals will use a range of scans, tests and checks to decide whether you have osteoporosis (or another bone condition) and whether you need a prescribed osteoporosis drug treatment.

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Diagnosing osteoporosis (nhs.uk, 2018)Risk assessment toolsIf your doctor suspects you have osteoporosis, they can make an assessment using an online programme, such as FRAX or Q-Fracture.These tools help to predict a person's risk of fracture between the ages of 40 and 90. The algorithms used give a 10-year probability of hip fracture and a 10-year probability of a major fracture in the spine, hip, shoulder or forearm.DEXA scanThey may also refer you for a DEXA (DXA) scan to measure your bone mineral density. It's a short, painless procedure that takes about 5 minutes, depending on the part of the body being scanned.Your bone mineral density can be compared to the bone mineral density of a healthy young adult and someone who's the same age and sex as you. The difference is calculated as a standard deviation (SD) and is called a T score.Standard deviation is a measure of variability based on an average or expected value. A T score of:above -1 SD is normal between -1 and -2.5 SD is defined as decreased bone mineral density compared with peak bone massbelow -2.5 is defined as osteoporosis

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Diagnosing osteoporosis (nhs.uk, 2018)Risk assessment toolsIf your doctor suspects you have osteoporosis, they can make an assessment using an online programme, such as FRAX or Q-Fracture.These tools help to predict a person's risk of fracture between the ages of 40 and 90. The algorithms used give a 10-year probability of hip fracture and a 10-year probability of a major fracture in the spine, hip, shoulder or forearm.DEXA scanThey may also refer you for a DEXA (DXA) scan to measure your bone mineral density. It's a short, painless procedure that takes about 5 minutes, depending on the part of the body being scanned.Your bone mineral density can be compared to the bone mineral density of a healthy young adult and someone who's the same age and sex as you. The difference is calculated as a standard deviation (SD) and is called a T score.Standard deviation is a measure of variability based on an average or expected value. A T score of:above -1 SD is normal between -1 and -2.5 SD is defined as decreased bone mineral density compared with peak bone massbelow -2.5 is defined as osteoporosis

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bisphosphonates
- drug : alendronate, ibandronate, risedronate, zoledronic acid

antibody
-denosumab --> inject twice a year

hormone-related medications
-SERMs
-Calcitonin
-PTHs --> teriparatide, abaloparatide

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-Backache-A gradual loss of height and an accompanying stooped -posture-Fractures of the spine, wrist, or hip-A bone fracture that occurs much more easily than expected 

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-Backache-A gradual loss of height and an accompanying stooped -posture-Fractures of the spine, wrist, or hip-A bone fracture that occurs much more easily than expected 

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Treatment
Medical treatment like
Bisphosphonates and
Selective oestrogen receptor modulators (SERMs)

Parathyroid hormone (teriparatide)

Parathyroid hormone is produced naturally in the body. It regulates the amount of calcium in bone.

Hormone replacement therapy (HRT)

HRT is sometimes recommended for women who are experiencing the menopause, as it can help control symptoms.

Calcium and vitamin D supplements

Calcium is the major mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones.

Testosterone treatment

In men, testosterone treatment can be useful when osteoporosis is caused by insufficient production of male sex hormones (hypogonadism).

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Depends on which bones have been fractured and when the treatment is started (detected). E.g. Hip fractures are dangerous for elderly. 20% die within a year after the fracture, 1/3 will regain their lost function

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1/3 women over 50 will experience osteoporotic fractures as will 1/5 men. 200 million people world-wide suffer from this disease, approximately 30% of all post menopausal women in USA and Europe, 40 % of these women and 15-30% of men will sustain one or more fractures in their remaining time. Theres an 86% increased chance of getting a second fracture after the first. vertebral fractures rarely reported and most go undiagnosed. hip fractures is approximately 1.7 million worldwide. Women who have hip fractures have 10-20% higher mortality than other women their age. Hip fractures are projected to increase 240% in women and 310% in men.
https://www.iofbonehealth.org/epidemiology

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prior fragility fracture

female sex

white ancestry

older age (>50 years for women and >65 years for men)

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DXA (peripheral DXA) measures bone mass at the forearm, finger and heel

SXA (single-energy X-ray absorptiometry) measures the heel or wrist

DPA (dual photon absorptiometry) measures the spine, hip or total body

SPA (single photon absorptiometry) measures the wrist

QCT (Quantitative Computed Tomography) measures the spine or hip

PQCT (peripheral QCT) measures the forearm

QUS (Quantitative Ultrasound) uses sound waves to measurethe heel or finger

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Osteoporosis develops slowly over several years.
Early signs:
1.Backpains, caused by fractured or collapsed vertebra
2. Gradual loss of height
3. A stooped postured
4. A bone fracture that occurs much more easily (spine, wrist, hip)

Osteoporosis does not cause pain unless a bone is broken. However, spinal fractures are the most common chronic pain.

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- low bone mass
- abnormal bone architecture
- increase bone fragility
- risk of fracture

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By 2050, worldwide incidence of hip fracture is projected to increase by 240% in women and 310% in men. The estimated number of hip fractures worldwide will rise from 1.66 million (1990) to 6.26 million in 2050.

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Biphosphonates
- slow the rate that bone is broken down in your body. This maintains bone density and reduces the risk of fracture

Selective oestrogen receptor modulator (SERMs)
- maintain bone density and reduce the risk of fracture, particularly of the spine

Parathyroid hormone
- stimulate cells that create new bone (osteoblasts)

Calcium and Vitamin D Supplements
- increase calcium and vitamin D for healthy bones

Hormone Replacement Therapy
- maintain bone density and reduce the risk of fracture during treatment